NYAPRS Note: President of the United Hospital Fund, Jim Tallon, describes below some of the efforts of NY to coordinate a massive systems transformation. He includes aspects of the change that we rarely highlight, such as the State Health Innovation Plan and the SHIN-NY, which will integrate medical records across a shared platform. What he doesn’t articulate in this article is that these critical questions are just as applicable for the changes being made to health care for persons with special needs or disabilities. The BH managed care transition for adults and children, LTC management, downstate FIDA demonstration, adult and nursing home community transitions, hospital restructuring, and community rehabilitation movement all raise questions about functionality, quality, and efficient care. One drawback of this total system change is that the agencies guiding it are themselves fragmented and have not ultimately worked in coordinated step. Integrating policy directions may be a way toward reducing overlap and sub-standard implementation, toward standards worthy of being emulated by other states seeking ACA opportunities in the future.
Dramatic Changes, Critical Questions
United Hospital Fund; Jim Tallon, 6/26/2014
New ideas are a New York tradition, but the current scope and pace of health care innovation in our state reach a whole new level. The changes being wrought are fundamental, transforming how care is delivered, how dollars flow among provider organizations, and how new information technology is being harnessed to support these transitions on patients’ behalf.
Reflecting the “triple aim” mantra of national health reform discussions, New York’s efforts are on track to achieve substantial progress toward better health, better care, and lower costs within this decade.
MEDICAID REFORMS—AND MORE
Today, the focus of attention for policymakers and providers is on DSRIP, the Delivery System Reform Incentive Payment program, the largest component of New York’s $8 billion federal Medicaid waiver. DSRIP supports the creation of PPSs, Performing Provider Systems, structures that integrate and coordinate care among multiple organizations to achieve specific clinical improvements in individuals’ health conditions, and focus on the health of targeted populations. This will enable New York to reinvest Medicaid savings to transform health care delivery.
Additionally, the waiver includes resources to counter short-term financial instability among health care providers that are especially at risk, and to support additional improvements such as retraining for the long-term care workforce.
The long-awaited Medicaid waiver is itself the most recent facet of the Medicaid Redesign Team activity begun under Governor Cuomo in 2011. That work has already capped Medicaid cost growth, simplified the administration of the State’s Medicaid program, moved away from fee-for-service Medicaid payments to care management for virtually all beneficiaries, and begun the integration of care, whether delivered by public or private providers of acute, primary, or long-term services.
As sweeping as this Medicaid reform initiative promises to be, the changes don’t stop there. A new appropriation in the State budget continues support for the Statewide Health Information Network–New York, or SHIN–NY, the information highway that will connect medical records among providers and give patients access to their medical information. This multi-year effort envisions a free flow of information, limited only by substantial privacy protections, to benefit patients wherever and in whatever circumstances they are.
During the summer ahead, New York will also respond to a federal invitation to request broader support of the State’s health care innovation plan, which extends improvements in health care delivery to include multiple insurers. A substantial reshaping of primary care—including the integration into it of behavioral or mental health services, to make primary care more comprehensive and effective—is just a part of this effort.
Also ahead is the continued growth and refinement of New York State of Health, the health insurance exchange established to implement the provisions of ACA, the Affordable Care Act. In its first enrollment cycle, well over 1 million New Yorkers applied for health insurance under the new marketplace, with more than 900,000 actually enrolling in Medicaid or in subsidized private insurance. By any standard, New York has stepped up to the ACA plate, with a performance in the highest rank among states.
ON-THE-GROUND ASSESSMENTS
Even by New York’s historical standards of health care leadership, these activities are milestones on an ambitious path toward health care transformation. It is important to remember, however, that the new organizations being created, largely built on contractual relationships, need to function not only conceptually but also in on-the-ground operations. It’s a lesson that we all surely saw in the implementation of Obamacare. Now, as we face the next generation of sweeping changes, and the need to fairly assess their impact, we must again be prepared for significant challenges.
This isn’t just about numbers on a page. It’s about asking, and responding to, the critical questions. Does the system work? Do the emerging organizations advance the highest standard of health care quality? Do they achieve better efficiency in using services? Do they actually, ultimately, make sense to 19 million New Yorkers? Our answers, at the end of this decade, will determine whether our New York standards will once again demonstrate to the nation that big change can be achieved and sustained.
http://www.uhfnyc.org/news/880989